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20-12-2010 | Diabetes | Article

Nephropathy progression in hypertensive Type 2 diabetes common

Abstract

Free abstract

MedWire News: The risk for progression of nephropathy among patients with Type 2 diabetes and hypertension may be higher than previously believed, research suggests.

Nearly half of the patients in the population-based study who had normoalbuminurea at baseline developed micro- or macroalbuminurea an average of just over 5 years later.

The US researchers say: "Our results suggest that the lifetime risk of nephropathy among patients with Type 2 diabetes may be greater than previously reported."

Progression through stages of nephropathy has not been well described in a large, well-characterized, population-based study, say Suma Vupputuri (Kaiser Permanente Georgia, Atlanta) and colleagues.

To rectify the situation, they identified 10,290 members of a managed care organization who had hypertension and Type 2 diabetes and had urine albumin-to-creatinine ratio (UACR) measured in 2001-2003, and again on at least two other occasions 3 to 5 years later.

Overall, 57% of patients had normoalbuminuria (<3.4 mg/mmol), 31% had microalbuminuria (3.4-3.8 mg/mmol), and 12% had macroalbuminuria (at least 33.9 mg/mmol) at baseline.

During a mean follow-up of 5.4 years, 40% of those with normoalbuminurea progressed to microalbuminurea, 6.3% progressed to macroalbuminurea, and 0.08% to end-stage renal disease.

The incidence of nephropathy progression was 94.7, 35.1, and 6.5 per 1000 person-years for normo-, micro-, and macro-albuminuria, respectively.

The authors note, in the journal Diabetic Research and Clinical Practice, that the use of ACE inhibitors and angiotensin receptor blockers was lower than expected, ranging from 61% to 67%, except among patients with macroalbuminuria at follow-up.

Age, diabetes duration, and glycated hemoglobin levels were significant predictors of progression.

The researchers conclude: "Our study suggests that developing successful strategies to prevent or slow the progression of nephropathy are needed as these may effectively reduce the burden of disease."

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010

By Anita Wilkinson